This invention relates to a device for colonic lavage, and to a method for using such a device, particularly for on-table retrograde lavage.
In emergency surgery a clean, well prepared bowel is required for safe colonic resection and anastomosis. Both antegrade and retrograde on-table lavage methods are known. Antegrade methods are more often used and require a further incision in the bowel to place a catheter to administer irrigation fluid.
U.S. Pat. No. 5,443,445 (Peters et al./Clinical Product Development Limited) describes an intra-operative colon irrigation system which includes a device having a tubular body with a forward end formed by a dome-shaped nozzle to prevent intussusception of the bowel, and a side tube including an outlet for the discharge of fecal matter from the device. A port is located at the other end of the tubular body, for the insertion of an ultrasonic device or for the injection of water or air under pressure.
However, retrograde methods would be preferred in that no additional incision of the bowel is required.
Hepworth et al., in Gut 1999; 44 (suppl.1), A134: TH533, have proposed a retrograde procedure for on-table lavage which comprises advancing a jet of irrigation fluid through the bowel as the lavage process proceeds.
A known device for such a retrograde lavage method comprises a rigid Y-connector to which three flexible tubes are connected. One tube is inserted in the bowel and another carries irrigation fluid, while the third leads to a container for the irrigated fecal material. This device has not proved ideal. In particular, the rigid Y-tube easily becomes blocked with fecal material and it is difficult to advance the irrigation fluid tube through the Y-connector as the lavage process proceeds. Furthermore, the xe2x80x9cYxe2x80x9d configuration of the connector prevents the insertion of a colonoscope through the device, a colonoscope being used after lavage to check the condition of the bowel.
It is an object of the present invention to provide a more suitable device for carrying out the process suggested by Hepworth et al. and to provide a method of using such a device.
Generally, this invention provides a device for colonic lavage, comprising a tubular body having a forward portion and a rearward portion, an opening at the front end of the forward portion for insertion into the bowel of a patient, a side tube including an outlet for the discharge of fecal matter from the device, thereby defining a continuous passage from the opening to the outlet, and a port located at the other end of the tubular body, and incorporating sealing means to enable the insertion of a hose into the device, the sealing means having a free internal dimension less than the minimum cross-sectional dimension of the passage, and wherein at least that portion of the tubular body which constitutes a junction between the forward portion and the side tube is flexible.
The invention also generally provides a method for colonic lavage by use of a device comprising a tubular body having a forward portion and a rearward portion, an opening at the front end of the forward portion for insertion into the bowel of a patient, a side tube including an outlet for the discharge of fecal matter from the device, thereby defining a continuous passage from the opening to the outlet, and a port located at the other end of the tubular body, the method comprising inserting the forward portion of the tubular body into the bowel of a patient, inserting a hose into the port to extend through the tubular body and through the opening into the colon of the patient, passing irrigation fluid through the hose to cleanse obstructed fecal matter from the colon, allowing cleansed fecal matter to be discharged from the tubular body through the outlet, and advancing the hose through the device further into the colon as obstructed fecal matter is cleansed therefrom.
The opening in the tubular body is preferably unobstructed, so as to allow cleansed fecal matter to pass freely into the device through the opening. This is in contrast to the device described in U.S. Pat. No. 5,443,445, referred to above, where the opening at the forward end of the tubular body is intentionally obstructed by a dome-shaped nozzle.
The port is preferably in straight line relationship with the opening in the tubular body. This enables the hose to be more easily advanced through the device in use, without any bends or turns, and also enables alternative components, such as a colonoscope, to be inserted through the device into the colon of the patient.
At least that portion of the tubular body which constitutes a junction between the forward portion and the side tube is flexible e.g. is formed of flexible material, so as to enable the operator to dislodge any blockage which may occur at this point, as a consequence of the build-up of fecal material in this region, by manipulating the flexible portions of the device. Most preferably the whole device is made of flexible material.
According to a preferred aspect of the invention, a discharge tube extends from the outlet to a sealable, preferably flexible, container. The discharge tube preferably has a concertina configuration to enable any blockage within the discharge tube to be dislodged by extending and contracting blocked section of the discharge tube. The discharge tube is preferably releasably connected to the container to enable the container to be easily exchanged when full. The construction of the container can be chosen such that when full, it is of a size and weight which can be easily disposed of safely.
The side tube is preferably shaped to constitute a hand grip, to ease control of the device by the operator.
The tubular body is preferably formed of a medical grade material such as PVC or silicone and may be manufactured by blow molding or dip molding. The forward and rearward portions of the tubular body and the side arm are usefully formed as an integral entity.
The sealing means is preferably an annular seal associated with the port. The seal may be formed of medical grade material such as PVC and secured to the tubular body by bonding e.g. with a medical grade bonding agent such as cyclohexanone.
The device according to the invention can be used together with a hose which is a close fit in the sealing means, the hose having a length exceeding the distance from the port to the opening, ideally having a length which is considerably longer than the device to enable the hose to be advanced as required through the colon of the patient, while continuing to be connected to the irrigation fluid source. The hose may be advanced through the device by hand. To assist the advance of the hose through the sealing means it is preferred to form the hose and the sealing means from low-friction material, or to coat these members with such a material.
The irrigation fluid will normally be a liquid, although the device is suitable for use with compressed air, or a mixture of air and liquid. A suitable liquid is a saline solution.